The justices of the U.S. Supreme Court heard arguments Tuesday in a case that pits California's right to run its prisons against the Constitution's guarantee that those behind bars get basic minimum medical care. At issue is a 2009 federal court order requiring California to take whatever measures are necessary to bring down the state's prison population by between 35,000 and 46,000 prisoners.

California's prison system, designed to house 80,000, housed twice that many by 2009, with gymnasiums, classrooms, even clinics converted to inmate living space. The result is that the state itself admits prisoners are routinely denied minimal medical care, resulting in some 112 deaths over the past two years.

A History Of Litigation

The Supreme Court has long held that prisoners are, in essence, wards of the state. Since they cannot find or consult doctors on their own, they must be provided basic medical care while in the state's custody.

Failure to provide basic care, the court has said, would violate the Constitution's ban on cruel and unusual punishment. And over the course of 20 years, federal courts have repeatedly found California to be in violation.

Finally, in 2008, a special three-judge panel was convened to deal with two lawsuits -- one that found the state had failed to provide care for inmates with acute mental illnesses like schizophrenia, and another that found the state had failed to provide rudimentary diagnosis and treatment for physically ill inmates.

Prison wardens and correction officials from across the country testified that unless overcrowding was reduced, sufficient medical care simply could not be provided. The three-judge court then ordered the state to reduce the prison population to 137 percent of capacity within two years.

Gov. Arnold Schwarzenegger said he didn't "blame the courts for stepping in" because he said the state for decades had ignored its "prison overcrowding crisis," refusing to do anything about the problem.

Nonetheless, the state appealed the court order, asserting it needed more time to comply.

Concerns About Public Safety

On Tuesday in the Supreme Court, lawyer Carter Phillips, representing California, said the lower court had not given adequate weight to public safety concerns. "The reality," said Phillips, "is that anytime ... you release 30,000 prisoners in a compressed period of time, I guarantee you there is going to be more crime and people are going to die on the streets of California."

Justice Ruth Bader Ginsburg noted that one of the cases under review has been pending for 20 years, with 70 orders issued by a single district court judge, and yet, said Ginsburg, "there's been no change. So how much longer do we have to wait? Another 20 years?"

Justice Sonia Sotomayor chimed in, asking when the state is going to "get around to" avoiding the "needless deaths" documented in the record. When, she asked, will the state treat catatonic prisoners "sitting for days in their feces in a dazed state?"

Phillips urged the court to give the state at least five years to resolve its problem in an orderly way, but pressed by Sotomayor, could not assure the court that five years was enough.

Jumping The Gun?

Based on the tenor of Tuesday's argument, it seemed likely that Justice Anthony Kennedy, a Californian, will cast the deciding vote. He noted the "massive expert testimony" that overcrowding is the principal cause of the state's failure to provide adequate medical care.

Kennedy said his problem with Phillips' argument is that "at some point the court has to say, 'You have been given enough time.' ... the court has to focus on the remedy ... and that, it seems to me, was a perfectly reasonable decision."

"Nobody doubts there have been very significant violations of constitutional rights [in] years gone by," Phillips said. But, he added, "there has been very significant movement" in recent years, "and if the court had not jumped the gun ... this process would have played itself out and we wouldn't be here."

Justice Stephen Breyer pointed to photographs online showing the conditions in California prisons. But Breyer noted caustically that he "reads the newspapers," and "it doesn't seem to me California has been voting a lot of money for new programs." So, without court action, he asked, what would happen in a prison system that everyone agrees has been violating the rights of the prisoners by failing to provide adequate medical care?

Lawyer Phillips replied that the state is planning to spend $2.3 billion on prison construction, but several justices noted that the promised money is not a done deal.

Other Options

Representing the prisoners, lawyer Donald Specter told the court that California is an outlier in the way it treats prisoners and in the number of people it imprisons for minor offenses.

Justice Samuel Alito interrupted to ask what justifies a court in ordering the release of 40,000 prisoners instead of ordering the building of more prisons or the hiring of more medical staff.

"This is not a release order," replied Specter. "It's a ... crowding reduction order. The court is not ordering the state to throw open the [prison] gates ... and release people." The state can move prisoners to out-of-state prisons; it can build more prisons. But, he said, just hiring more staff won't work, as the courts have found over the past 20 years.

Alito had other problems with the court order: What was the rationale for requiring the state to get to 137 percent of capacity? Why release prisoners who were not denied medical care? But most of all, he clearly viewed the order to decrease the prison population as dangerous.

"If I were a citizen of California, I would be concerned about the release of 40,000 prisoners," he said. Do you really believe, he asked, that such a release would not contribute to an increase in crime?

Specter noted that other states have reduced their prison populations without a crime increase.

Alito then pressed the prisoners' lawyer about the recidivism rate in the state. Specter replied that while overall it is 70 percent, the rate is only 17 percent for low-risk offenders of the kind that are contemplated for release here. And he observed that in California, just eliminating the mandatory return of technical parole violators -- people who, for instance, miss an appointment -- would mean some 17,000 fewer prisoners.

A State's Obligations

Chief Justice John Roberts pursued the subject of public safety, saying that the lower court had not made an adequate finding that there would be no threat. But Specter countered that the governor himself had made a proposal to release 37,000 prisoners over two years.

The chief justice then turned to another point. "My concern about this kind of institutional reform litigation is that the state is responsible for a lot of different things. What happens when you have this case and ... another court ordering the state to spend this much more on education for the disabled and another court saying you have got to spend this much more for something else? How does the state sort out its obligations?"

"In this case," replied Specter, "the court gave the state the maximum degree of flexibility" to make policy choices. But, he added, "the Constitution prevents the state from incarcerating somebody and then not providing them the basic medical care they need" so that they don't "die before their sentence is out."